Bottom Line:
Idiopathic CD4 T-lymphocytopenia (ICL) is characterized by depletions in the CD4+ T-cell subsets, without evidence of HIV infection.Immunodeficiency can exist in the absence of laboratory evidence of HIV infection, and T-cell subsets should be evaluated in patients who present with unusual opportunistic infections.We report a case of pulmonary cryptococcosis and lung cancer in a patient with persistently low CD4+ cell counts, without evidence of HIV infection.

ABSTRACTCryptococcus neoformans commonly causes opportunistic infections in immunocompromised patients, especially in patients with AIDS. CD4+ T-lymphocytopenia in AIDS indicates an increased risk of opportunistic infection and a decline in immunological function. Idiopathic CD4 T-lymphocytopenia (ICL) is characterized by depletions in the CD4+ T-cell subsets, without evidence of HIV infection. Immunodeficiency can exist in the absence of laboratory evidence of HIV infection, and T-cell subsets should be evaluated in patients who present with unusual opportunistic infections. We report a case of pulmonary cryptococcosis and lung cancer in a patient with persistently low CD4+ cell counts, without evidence of HIV infection.

Mentions:
A sputum gram stain and bacterial culture revealed no organisms. Direct examinations and sputum culture were negative for acid-fast organisms. Multiple thick-walled cavitary lesions, with nodules and consolidations in both lungs, were noted on chest radiography (Fig. 1). Multiple patch consolidations and multiple large pulmonary nodules with cavitary formations and severe wall thickening of subsegmental bronchi in the whole lung field were noted on the chest CT scan (Fig. 2). Fiberoptic bronchoscopy with transbronchial lung biopsy was performed for purposes of identification of any possible causative pathogen. On bronchoscopy, there were white exudate-covered nodules in the orifice of the anterior segment of the right upper lobe. An endobronchial biopsy was also performed. Histologic findings of the endobronchial biopsy showed moderately differentiated squamous cell carcinoma. Histologically, the transbronchial lung biopsy revealed multinodular peribronchial granulomas with central necrosis. Percutaneous needle aspiration cytology revealed yeast-form fungi, consistent with cryptococci (Fig. 3). A cerebrospinal fluid (CSF) cryptococcal antigen test, an India ink staining, and a fungal culture were all negative. Serum cryptococcal antigen was positive (1 : 16 titer).

Bottom Line:
Idiopathic CD4 T-lymphocytopenia (ICL) is characterized by depletions in the CD4+ T-cell subsets, without evidence of HIV infection.Immunodeficiency can exist in the absence of laboratory evidence of HIV infection, and T-cell subsets should be evaluated in patients who present with unusual opportunistic infections.We report a case of pulmonary cryptococcosis and lung cancer in a patient with persistently low CD4+ cell counts, without evidence of HIV infection.

ABSTRACTCryptococcus neoformans commonly causes opportunistic infections in immunocompromised patients, especially in patients with AIDS. CD4+ T-lymphocytopenia in AIDS indicates an increased risk of opportunistic infection and a decline in immunological function. Idiopathic CD4 T-lymphocytopenia (ICL) is characterized by depletions in the CD4+ T-cell subsets, without evidence of HIV infection. Immunodeficiency can exist in the absence of laboratory evidence of HIV infection, and T-cell subsets should be evaluated in patients who present with unusual opportunistic infections. We report a case of pulmonary cryptococcosis and lung cancer in a patient with persistently low CD4+ cell counts, without evidence of HIV infection.